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Detection of Architectural Distortion in Prior Mammograms via Analysis of Oriented Patterns
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False-Positive Recall and False-Positive Biopsy Rates in Mammography Screening: A TOSYMA Trial Subanalysis.

Stefanie Weigel1, Hans-Werner Hense2, Veronika Weyer-Elberich3

  • 1Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany.

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|September 16, 2025
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Summary
This summary is machine-generated.

Digital breast tomosynthesis (DBT) plus synthesized mammography (SM) demonstrated lower false-positive recall rates compared to digital mammography (DM) in screening. This advancement in breast imaging offers improved accuracy with fewer unnecessary biopsies.

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Area of Science:

  • Radiology and Medical Imaging
  • Oncology
  • Public Health Screening Programs

Background:

  • False-positive mammography results can negatively impact patient outcomes and reduce screening program efficiency.
  • Digital breast tomosynthesis (DBT) combined with synthesized mammography (SM) has shown potential for higher breast cancer detection rates.

Purpose of the Study:

  • To evaluate if the increased cancer detection rate of DBT plus SM, observed in the TOSYMA trial, is associated with elevated false-positive rates compared to standard digital mammography (DM).
  • To compare recall rates, biopsy rates, and positive predictive values between DBT plus SM and DM arms.

Main Methods:

  • The randomized TOmosynthesis plus SYnthesized MAmmography (TOSYMA) trial enrolled women aged 50-70 years, allocating them 1:1 to either DBT plus SM or DM.
  • Key metrics analyzed included true- and false-positive recall rates, false-positive biopsy rates, and positive predictive values of recalls and biopsies.
  • Follow-up for women with false-positive findings extended to 24 months; analyses were exploratory.

Main Results:

  • DBT plus SM showed a lower false-positive recall rate (40.2 per 1000) compared to DM (43.7 per 1000), particularly significant in the first screening round.
  • The positive predictive value of recall was higher with DBT plus SM (17.2%) than with DM (12.3%).
  • While the false-positive biopsy rate was slightly higher with DBT plus SM (7.8 per 1000) versus DM (6.0 per 1000), this was offset by a higher true-positive recall rate (8.4 vs. 6.2 per 1000).

Conclusions:

  • The TOSYMA trial's exploratory analysis suggests DBT plus SM yields lower false-positive recall rates than DM, especially in initial screenings.
  • The observed increase in false-positive biopsies with DBT plus SM was compensated by a greater number of detected breast cancers.
  • DBT plus SM represents a promising advancement in mammography screening, potentially improving diagnostic accuracy and reducing patient anxiety from false alarms.